Epidermoid cyst masquerading as dacryocystocele: case report and review.

A 21-month-old boy presented with a medial canthal mass since birth that was clinically consistent with a dermoid or epidermoid cyst. Computed tomography and neuroradiologic interpretation questioned the clinical diagnosis- as the lesion was radiographically consistent with a dacryocystocele. Excision via anterior medial orbitotomy revealed an epidermoid cyst. Lacrimal irrigation was normal at the time of surgery. Diagnosis of orbital lesions in the region of the lacrimal sac can be confounded by radiographic imaging. This case demonstrates the importance of clinical evaluation in differentiating benign congenital orbital tumors in the peri-lacrimal region, from frank lacrimal pathology.

Pulled-in-two syndrome in a patient with heavy eye syndrome.

We report the case of a 73-year-old woman diagnosed with heavy eye syndrome who underwent loop myopexy of the superior rectus and lateral rectus muscles after suffering pulled-in-two syndrome caused by exploration of the medial rectus muscle, which could not be recovered. Given that intraoperative forced ductions remained positive after loss of the muscle, a loop myopexy of the superior rectus muscle and lateral rectus muscles was performed. Postoperatively the patient regained full adduction, and her esotropia improved notably.

Supramaximal doses of botulinum toxin for refractory blepharospasm.

PURPOSE: To investigate the response to supramaximal doses of botulinum toxin in patients with refractory blepharospasm. DESIGN: Prospective, nonrandomized, open-label interventional case series. PARTICIPANTS: Eight consecutive patients with blepharospasm requiring injections every 2 months despite receiving 100 U of botulinum toxin per session. INTERVENTION: Increasing the dose of botulinum toxin per session above the conventional maximum. MAIN OUTCOME MEASURES: Duration of treatment effect and patients' subjective response to treatment. RESULTS: Supramaximal dosages were well tolerated. Seven of 8 patients had a prolonged interval between injections relative to that associated with their previous dosing regimen. Four of the patients elected to continue with the new dosage. CONCLUSION: In select patients with essential blepharospasm who are refractory to standard treatment regimens, increasing the dosage of botulinum toxin above 100 U per session may decrease the interval between injections, improve the patient's quality of life, or both.

Hyperbaric oxygen therapy for radiation-induced optic neuropathy.

INTRODUCTION: Radiation-induced optic neuropathy (RON) is an infrequent but devastating consequence of radiation exposure to the visual pathways, usually following months to years after the treatment of paranasal or intracranial tumours. Hyperbaric oxygen (HBO) therapy is one of several therapies that have been tried for this condition. The purpose of this review is to describe the clinical characteristics of RON, the rationale for the use of HBO in this condition, and the available clinical data on its safety and efficacy. METHODS: MEDLINE searches were performed on radiation optic neuropathy, hyperbaric oxygen therapy, and similar terms, and selected references were reviewed. The results were combined with the experience at our own institution. RESULTS: RON typically follows a fulminant course with characteristic symptoms, examination findings, and imaging. The threshold for prior radiation exposure depends upon the delivery system used and patient characteristics. Therapy with anticoagulants or steroids has been unsuccessful. While there are case reports in the literature of successful treatment with HBO, therapy with HBO has to be initiated soon after the onset of vision loss, and even then yields variable results at best. CONCLUSIONS: There is still no consistently successful treatment for RON. HBO may be attempted in selected cases, but the prognosis for preservation of vision remains grim.

Phase II trial of idiotype vaccination in previously treated patients with indolent non-Hodgkin's lymphoma resulting in durable clinical responses.

PURPOSE: To evaluate idiotype (Id) vaccination as a single agent in previously treated patients with indolent non-Hodgkin's lymphoma. PATIENTS AND METHODS: Patients underwent biopsy for determination of their lymphoma-specific Id sequence. Recombinant Id protein was manufactured and covalently linked with keyhole limpet hemocyanin (KLH) to generate Id/KLH. Patients received Id/KLH 1 mg on day 1 subcutaneously, with granulocyte-macrophage colony-stimulating factor 250 mug on days 1 to 4, monthly for 6 months. Booster injections were administered until progression. Both clinical and immune responses were evaluated. RESULTS: Thirty-two previously treated patients received at least one injection of Id/KLH, and 31 were assessed for efficacy. Responses were observed in four patients (one complete response and three partial responses). Median time to onset of response was 5.9 months (range, 2.3 to 14.1 months). Median duration of response has not been reached but should be at least 19.4 months (range, 10.4 to 27.2+ months). Median time to progression is 13.5 months. The most common adverse events were mild to moderate injection site reactions. Six (67%) of nine patients tested demonstrated a cellular immune response, and four (20%) of 20 patients demonstrated an antibody response against their Id. CONCLUSION: This trial demonstrates that Id/KLH alone can induce tumor regression and durable objective responses. Further study of Id/KLH is recommended in other settings where efficacy may be further enhanced as in first-line therapy or after cytoreductive therapy.

Safety and efficacy of the technique of complete tenon's membrane excision and mitomycin C in pterygium surgery.

PURPOSE: Despite the established efficacy of mitomycin C (MMC) in preventing recurrence after pterygium surgery, there is no consensus on the optimal operative technique or dose of MMC. METHODS: The authors retrospectively evaluated 90 single-headed pterygium resections performed with excision of the entire pterygium to the plica and removal of all Tenon's membrane from the scleral bed and rectus muscle. Bare sclera was exposed to 0.4 mg/mL MMC for 5 minutes for primary pterygia and 6 minutes for recurrent pterygia. These procedures were compared to a previous series of 58 procedures using bare sclera technique with MMC, but without extensive Tenon's membrane removal. RESULTS: Extensive Tenon's membrane removal was associated with significantly fewer recurrences (6.7% vs. 21%; P< or =0.025) and significantly less pyogenic granuloma formation (24.4% vs. 40%; P< or =0.05). In addition, there were no vision-threatening complications, such as scleral melting or persistent corneal epithelial defects, in any of the patients. CONCLUSIONS: These findings suggest that complete removal of all Tenon's membrane in the affected quadrant combined with topical MMC in the aforementioned dose is a safe method of pterygium excision with a low rate of recurrence and pyogenic granuloma formation.